Close Contact Spreads Saudi Virus

By

Ellen Knickmeyer in Riyadh, Saudi Arabia, and

Leila Hatoum in Dubai

Updated May 16, 2013 7:08 p.m. ET

The latest and largest-yet outbreak of a lethal new SARS-like virus centered on Saudi Arabia seems to be spreading chiefly by close person-to-person contact, the World Health Organization and Saudi doctors said on Thursday, as a doctor and nurse who had treated patients sickened by the disease became the latest confirmed cases in the eastern part of the kingdom.

Since the first known appearance of the novel coronavirus, in the Middle East in April 2012, 40 cases have been confirmed world-wide.

Health officials say the current, month-old cluster in the eastern Saudi city of Hofuf remains largely linked to hospitals rather than moving widely in communities at large.

ENLARGE

Worryingly, however, the surge of confirmed reported cases in Hofuf—21, with nine deaths—has more than doubled the toll of the yearlong outbreak in just three weeks. That has raised fears of the virus as a graver global threat, especially with the peak period of Muslim pilgrimages to Saudi Arabia coming this summer and fall.

The WHO said late Wednesday that the two health workers, one in critical condition, appear to have been the first instances of patient-to-medical worker transmission in the yearlong outbreak.

The two were a doctor and a nurse, said
Tariq Madani,
a professor of medicine and infectious diseases at Saudi Arabia's King Abdulaziz Hospital, and a former adviser to the Saudi Ministry of Health.

The coronavirus comes from the same family as the SARS virus that killed more than 700 people in Asia a decade ago. Since the novel coronavirus's discovery, the WHO said it has recorded 40 confirmed cases and 20 deaths in Saudi Arabia, Qatar, France, Germany, Jordan and Britain. The disease typically causes severe lower-respiratory infections.

Limited, person-to-person contact appears to have been the means of transmission in most of the illnesses in the Hofuf outbreak, WHO spokesman
Gregory Härtl
in Geneva said Thursday. When the disease first appeared months ago in this city of 1.2 million grown up around an ancient oasis and date-palm farms, many of those sickened were found to have had contact with camels or goats. Authorities have yet to identify the original animal source of the virus, or determine which animals may transmit the virus to humans.

At a conference on infectious diseases in Dubai on Thursday, Saudi doctors and experts on infectious diseases stressed measures that have been taken against the virus. These include health officials last week inviting the WHO and other international investigators, warning hospitals around the kingdom to be on alert, and providing provincial hospitals with disease-surveillance technology.

With the spread still limited, and typically coming after prolonged contact such as among family members, "there is no worry of a pandemic," said Dr. Madani.

Outside Saudi Arabia, however, Islamic organizations this week began expressing alarm about the outbreak ahead of this summer and autumn's peak pilgrimage seasons. The hajj, which this year occurs in October, each year draws three million Muslims from around the world to worship at the Saudi city of Mecca, Islam's holiest site.

In London, an association for Hajj pilgrims from Britain called the virus "a great cause for concern" for pilgrims. It cited three infections, including two deaths, in February in a British family infected with coronavirus when the father returned home from praying in Mecca.

In Cairo, a Muslim Brotherhood official urged preventive measures ahead of the coming surge of pilgrims to Saudi Arabia.

Saudi Arabia's monarchy bases much of its legitimacy on its mission of protecting pilgrims and Islam's holy sites. The ruler, Abdullah, officially is titled not king but "custodian of the two holy mosques" of Mecca and nearby Medina.

Since the virus first appeared, "the immediate need was to ensure the safety of the three million Hajj pilgrims," deputy Saudi Health Minister
Ziad Memish
wrote in the May edition of The Lancet, a British-based medical journal.

Asked this week if the virus had changed so as to spread more easily among people, Dr. Memish said, "We don't think so."

The WHO's Mr. Härtl said "the question is open" whether the increase in the disease experienced in eastern Saudi Arabia was a result mainly of more testing for the virus—or an actual surge in the number of illnesses with the coronavirus.

At twilight on Thursday in Hofuf, the scene of the outbreak, nurses sat at tables near the entrances of the 120-bed al Moosa private hospital that has confirmed the majority of cases since May, offering masks and gloves to any who wanted them. Few of the staff wore masks.

A woman, her face covered by the niqab worn by some religiously observant women, held a baby as she sat waiting, and a man with children talked to admissions staff.

A hospital official confirmed that the facility was taking only emergency cases, because of the outbreak. Appearing cleaner, better-equipped and more modern than the faded, aged public hospitals in the city, al Moosa hospital is internationally certified, and had been one approved by Saudi Arabia's Aramco oil company for its workers.

An Aramco spokesman declined to comment Thursday on the oil giant's response to the coronavirus. Family members of three of the ill said one of the first cases in Hofuf was a retired Aramco employee, some of whose family had been treated at Aramco-approved facilities.

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